Cultural Norming, Family Help‐Seeking and Early Developmental Screening in Malay‐Indonesian Contexts

Dear Editor,

Kappelt et al. (2024) importantly remind us that early developmental risk should be identified before disparities become more established and before opportunities for timely intervention are missed. This discussion is especially relevant in culturally diverse contexts, including Malay‐Indonesian communities, where developmental screening is not merely a technical process of measuring milestones but also a cultural process of interpreting children's behaviour, family expectations and pathways to care.

Cultural calibration is necessary to improve the validity and contextual relevance of developmental screening tools, particularly when they are applied in culturally diverse communities. Malay‐Indonesian child‐rearing values such as adat, hormat, budi bahasa and gotong royong may shape children's emotional restraint, respect toward adults, cooperative behaviour, verbal expression, eye contact and peer engagement (Sabanathan et al. 2015; Lansford 2022). Without local norming and validation, instruments developed in other sociocultural settings may risk overidentification, inappropriate referral or misinterpretation of culturally normative behaviours; conversely, they may also overlook developmental concerns that are expressed differently in everyday family life.

However, cultural sensitivity should not be confused with cultural relativism. Some social‐communication indicators, including joint attention, pointing to show or share interest, response to social engagement and patterns of eye contact, remain clinically important and relatively cross‐culturally meaningful for identifying children at risk for autism spectrum disorder. Unlike some culturally variable developmental tasks, such as expectations about how many blocks a child can stack at a particular age, core social‐communication indicators require culturally sensitive interpretation without weakening their clinical significance. The central aim of social–emotional screening should therefore remain early identification of autism risk, because early intervention can improve developmental trajectories (Zwaigenbaum et al. 2015).

Inequity in early identification also does not occur only through misclassification at the screening stage. In Indonesia, even when developmental differences are recognised, families may delay professional evaluation or intervention because autism and related developmental differences can be interpreted through spiritual, moral or religious explanations. Riany et al. (2016) showed that Indonesian beliefs about autism may include explanations such as karma, divine will or spiritual causation. These beliefs may redirect some families toward religious figures, faith healers, traditional healers or extended family networks before they access health or developmental services.

Thus, the challenge may occur at three connected levels: the cultural sensitivity of the screening instrument, the family's access to health support after detection and the cultural responsiveness of providers who communicate results and guide referrals. Local norming and culturally responsive support address different stages of the same pathway, but they make a difference in different ways. Norming instruments to local culture improve the validity of detection by ensuring that screening items, examples, thresholds and interpretations fit the local population. Providing culturally responsive support improves the post‐screening pathway by ensuring that results are communicated respectfully, families understand developmental risk, stigma and blame are reduced and referrals are more likely to be accepted. Providers therefore need not only valid tools but also the ability to acknowledge family belief systems without endorsing harmful delay, explain screening results in non‐stigmatising language and guide families toward evidence‐based evaluation and intervention. For Malay‐Indonesian communities, developmental screening should be locally valid, clinically sensitive and embedded within referral systems that families can trust; it should not end with classification but should begin culturally respectful communication, timely referral and equitable access to early intervention.

Author Contributions

Elindra Yetti: conceptualization, writing – original draft. Siti Fadillah: conceptualization, writing – review and editing, writing – original draft. Ade Dwi Utami: writing – review and editing.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.